Mortality Information Research Articles

A Detailed Analysis of Cardiac Rehabilitation on 180-Day All-Cause Hospital Readmission and Mortality.

Cardiac rehabilitation (CR) is endorsed for coronary artery disease (CAD), but studies report inconsistent findings regarding efficacy. The objective of this study was to determine whether confounding factors, potentially contributing to these heterogeneous findings, impact the effect of CR on all-cause readmission and mortality. Patients (n = 2641) with CAD, CR eligible, and physically able were identified. Electronic medical records were inspected individually for each patient to extract demographic, clinical characteristic, readmission, and mortality information. Patients (n = 214) attended ≥1 CR session (CR group). Survival was considered free from: all-cause readmission; or composite outcome of all-cause readmission or death. Cox proportional hazards models, adjusting for demographics, comorbidities, and discharge criteria, were used to determine HR with 95% CI and to compare 180-d survival rates between the CR and no-CR groups. During 180 d of follow-up, 12.1% and 18.7% of the CR and non-CR patients were readmitted to the hospital. There was one death (0.5%) in the CR group, while 98 deaths (4.0%) occurred in the non-CR group. After adjustment for age, sex, race, depression, anxiety, dyslipidemia, hypertension, obesity, smoking, type 2 diabetes, and discharge criteria, the final model revealed a significant 42.7% reduction in readmission or mortality risk for patients who attended CR (HR = 0.57: 95% CI, 0.33-0.98; P = .043). Regardless of demographic characteristics, comorbidities, and cardiovascular discharge criteria, the risk of 180-d all-cause readmission or death was markedly decreased in patients who attended CR compared with those who did not.

Urinary Albumin-to-Creatinine Ratio in Normal Range, Cardiovascular Health, and All-Cause Mortality

Although cumulative evidence suggests that elevated urinary albumin-to-creatinine ratio (UACR) in the normal range (<30 mg/g) may be associated with an increased risk of mortality, few studies have investigated whether cardiovascular health (CVH) modifies the harmful outcomes of high-normal UACR. To investigate associations of traditionally normal UACR and CVH with all-cause mortality. This cohort study used National Health and Nutrition Examination Survey data from 2005 through 2018 and linked mortality information until 2019. Data were analyzed from March 1 through October 31, 2023. The study included adult participants aged 20 to 79 years with a normal UACR (<30 mg/g) based on Kidney Disease: Improving Global Outcomes criteria. The UACR was treated as a continuous variable and categorized into tertiles delineated as low (<4.67 mg/g), medium (4.67-7.67 mg/g), and high (7.68 to <30 mg/g). Cardiovascular health was assessed using Life's Essential 8 scores and grouped as poor (0-49 points), moderate (50-79 points), and ideal (80-100 points). Multivariable Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% CIs for associations of UACR with all-cause mortality in total participants and as stratified by CVH groups. The study included 23 697 participants (mean [SD] age, 45.58 [15.44] years; 11 806 women [49.7%] and 11 891 men [50.3%]). During the median 7.8 years (range, 4.5-11.1 years) of follow-up, 1403 deaths were recorded. Near-linear associations were observed for continuous UACR and CVH with all-cause mortality. Compared with the low UACR group, high UACR in the normal range showed an increased mortality risk in the moderate and poor CVH groups (CVH [50-79]: HR, 1.54 [95% CI, 1.26-1.89]; CVH [0-49]: HR, 1.56 [95% CI, 1.10-2.20]), with a significant multiplicative interaction of UACR and CVH (P < .001). The findings suggest that high UACR within the normal range is associated with a significantly increased risk of all-cause mortality, with the association more pronounced in adults with poor CVH status. These findings highlight the importance of risk management for early kidney dysfunction, particularly among individuals with poor CVH.

Cancer mortality and premature deaths among hairdressers in Brazil

Hairdresser is an occupation classified by the International Agency for Research on Cancer as probably carcinogenic (Group 2A) for lung and bladder cancer, but evidence is accumulating on its association with other cancer types. To our knowledge, this is the first study aimed to compare the cancer mortality and premature mortality between hairdressers and other workers in Brazil. Methods: In this exploratory study, information on deaths by selected cancers that occurred in Brazil, from 1996 to 2020, among workers aged 20-70y, with identified occupation was gathered from the Brazilian Mortality Information System. Sociodemographic characteristics, sex-specific mortality ratio, and Years of Potential Life Lost (YPLL) were compared between hairdressers, service workers, and general workers. We used logistic regression models to estimate crude (ORC) and adjusted (ORADJ) odds ratios. Models were adjusted by age, educational level, and ethnicity. We also used Poisson regression models to compare the YPLL rates across the occupational groups. Results: From 1996 to 2020, 23 557 deaths occurred among hairdressers, 576 428 among service workers, and 13 332 996 among general workers in Brazil. Higher mortality ORs and YPLL were observed for several types of cancer among hairdressers, compared to service and general workers, especially for women. Hairdressers' mortality was significantly higher among whites, women, younger workers, and those who completed high school. Female hairdressers had significantly higher odds of dying from cancer of the digestive, respiratory, reproductive, urinary, and hematological systems, both in crude and adjusted models. For male hairdressers, higher odds were found only for urinary tract and bladder cancer, while other significant associations indicated lower mortality than the comparison groups. YPLL analyses revealed significant premature deaths among Brazilian hairdressers. In women, this was more evident among those who died of neoplasms of salivary glands, bones and articular cartilages, and acute lymphoid leukemia; in men, tongue, pharynx, and thyroid. Conclusions: Our results suggest that Brazilian female hairdressers are more likely to die from several cancers, with potential consequences on premature deaths. Causal associations to occupational risks, such as exposure to chemicals, should be investigated by observational epidemiologic studies. Meanwhile, it is important to promote public policies, regulations, and Occupational Safety and Health (OSH) strategies to protect hairdressers’ health, mitigate occupational risks, and ensure safe workplaces.

Record Linkage for Malaria Deaths Data Recovery and Surveillance in Brazil.

The objective is to describe the results and the methodological processes of record linkage for matching deaths and malaria cases. A descriptive cross-sectional study was conducted with probabilistic record linkage of death and malaria cases data in Brazil from 2011 to 2020 using death records from the Mortality Information System (SIM) and epidemiological data from the Notifiable Diseases Information System (Sinan) and Epidemiological Surveillance Information Systems for malaria (Sivep-Malaria). Three matching keys were used: patient's name, date of birth, and mother's name, with an analysis of cosine and Levenshtein dissimilarity measures. A total of 490 malaria deaths were recorded in Brazil between 2011 and 2020. The record linkage resulted in the pairing of 216 deaths (44.0%). Pairings where all three matching keys were identical accounted for 30.1% of the total matched deaths, 39.4% of the matched deaths had two identical variables, and 30.5% had only one of the three key variables identical. The distribution of the variables of the matched deaths (216) was similar to the distribution of all recorded deaths (490). Out of the 216 matched deaths, 80 (37.0%) had poorly specified causes of death in the SIM. The record linkage allowed for the detailing of the data with additional information from other epidemiological systems. Record linkage enables data linkage between information systems that lack interoperability and is an extremely useful tool for refining health situation analyses and improving malaria death surveillance in Brazil.

Gynaecological cancer incidence and mortality trends in a Brazilian State with medium human development index: A 22-year analysis

ObjectiveThis study aimed to analyse trends in incidence and mortality rates of gynaecological cancer (GC) in Sergipe, a medium Human Development Index (HDI) state in northeastern Brazil during 1996–2017. MethodsData were obtained from the Population-based Cancer Registry of Aracaju and Brazilian Mortality Information System database. We included vulvar (VUC), vaginal (VAC), cervical (CC), uterine (UC; C54-C55), ovarian (OC), placental (PC), and unspecified female genital organ cancers. Crude rates, and age-standardised incidence and mortality rates (ASIR and ASMR, respectively) were calculated using a denominator of 100,000 women. We assessed changes in trends using the annual percentage change (APC) and the average APC (AAPC), using the Joinpoint Regression Program. ResultsFrom 1996–2017, GC ASIR exhibited a declining trend (AAPC: −3.1), while ASMR increased (AAPC: 2.1). CC had the highest ASIR and ASMR over the years, ranging from 11.6 to 34.3 cases and 4.2–9.0 deaths per 100,000, respectively. Annual decreases in ASIR were observed for CC (AAPC: −5.2) and VAC (AAPC: −5.5). OC saw an increase in mortality rates (AAPC: 1.9; 1996–2017), and CC experienced an increase during 1996–2003 (APC: 6.9). VUC displayed a substantial rise in ASMR from 2001 to 2009 (APC: 27.1), followed by a decrease (APC: −11.3). An increase in mortality trends for UC was observed during 1996–2004 (APC: 10.0), while its ASIR remained relatively unchanged over the years. ConclusionWhile overall GC incidence trends declined, mortality rates either increased or failed to decrease significantly. Therefore, additional efforts are required to enhance prevention, diagnosis, and treatment strategies, aimed at reducing and managing the burden of GC in the future.

Increased cardiovascular mortality in patients with mechanically expandable transcatheter aortic valve and without permanent pacemaker

IntroductionUse of the mechanically expandable transcatheter aortic valve (MEV) has been recently linked to increased risks of valve dysfunction and cardiovascular mortality. The risk of developing conduction disturbance with the...

Temporal analysis of mortality from preventable causes in the first 24 hours of life, 2000-2021.

to analyze the temporal pattern and estimate mortality rates in the first 24 hours of life and from preventable causes in the state of Pernambuco from 2000 to 2021. an ecological study, using the quarter as the unit of analysis. The data source was made up of the Mortality Information System and the Live Birth Information System. The time series modeling was conducted according to the Autoregressive Integrated Moving Average Model. 14,462 deaths were recorded in the first 24 hours of life, 11,110 (76.8%) of which being preventable. It is observed from the forecasts that the mortality rate in the first 24 hours of life ranged from 3.3 to 2.4 per 1,000 live births, and the mortality rate from preventable causes ranged from 2.3 to 1.8 per 1,000 live births. the prediction suggested progress in reducing mortality in the first 24 hours of life in the state and from preventable causes. The ARIMA models presented satisfactory estimates for mortality rates and preventable causes in the first 24 hours of life.

Análise temporal da mortalidade por causas evitáveis nas primeiras 24 horas de vida, 2000-2021

Objective: to analyze the temporal pattern and estimate mortality rates in the first 24 hours of life and from preventable causes in the state of Pernambuco from 2000 to 2021. Method: an ecological study, using the quarter as the unit of analysis. The data source was made up of the Mortality Information System and the Live Birth Information System. The time series modeling was conducted according to the Autoregressive Integrated Moving Average Model. Results: 14,462 deaths were recorded in the first 24 hours of life, 11,110 (76.8%) of which being preventable. It is observed from the forecasts that the mortality rate in the first 24 hours of life ranged from 3.3 to 2.4 per 1,000 live births, and the mortality rate from preventable causes ranged from 2.3 to 1.8 per 1,000 live births. Conclusion: the prediction suggested progress in reducing mortality in the first 24 hours of life in the state and from preventable causes. The ARIMA models presented satisfactory estimates for mortality rates and preventable causes in the first 24 hours of life.

Overall Survival Outcomes in Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma Patients with High-Risk Molecular-Cytogenetic Features Treated with 1L Ibrutinib: A Comparative Effectiveness Study Using the Flatiron Health Data

Introduction: In individuals diagnosed with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL), high-risk features are associated with an unfavorable outcome. Evidence is lacking in comparing the overall survival (OS) of a high-risk group (HRG) vs. a non-high-risk group (NHRG). This large retrospective cohort study, using data from the Flatiron Health CLL Core Registry electronic medical records (EMR), included 1,242 CLL/SLL patients treated with first-line (1L) single-agent ibrutinib. This study compared the OS of patients from the HRG (presence of deletion 17p [del(17p)], or deletion 11q [del(11q)], or unmutated immunoglobulin heavy-chain variable region gene [IGHV]) with that of patients from the NHRG (del[17p] absence, del[11q] absence, and mutated IGHV). This study also included a sensitivity analysis with an alternative high-risk definition and a subgroup analysis for Medicare patients. Methods: The Flatiron Health EMR data includes patients with confirmed CLL/SLL diagnosis using both diagnosis code and chart abstraction. Patients aged ≥18 years were included if they initiated single-agent ibrutinib 28 days before index date (1L initiation+28 days) between 04 March 2016 and 31 January 2023. Patients were excluded if there was missing or incomplete information on their first systemic therapy or on the genetic variables of interest, or if they had other malignancies (≥2 diagnosis codes ≥30 days apart) within the prior 12 months before 1L initiation. OS (the time interval between the index date and all-cause mortality date) was assessed using Kaplan-Meier survival estimators, censoring patients without mortality information at the last activity date. COX proportional hazard model was used for pairwise comparison analysis, treating NHRG as the reference group. Potential confounders (including baseline covariates such as gender, age, race, stage, ECOG PS, comorbidities, practice type, disease type, and other biomarkers) were adjusted using inverse probability of treatment weighting (IPTW). The Medicare subgroup included patients with Medicare as the single payer or one of the multiple payers at ibrutinib initiation, which serves as a proxy for the elderly group (aged ≥65 years). A sensitivity analysis was conducted by defining HRG as those with del(17p) presence and/or unmutated IGHV and NHRG as those with del(17p) absence and mutated IGHV. Flatiron Health mortality data were obtained from multiple sources including EMR, the U.S. Social Security Death Index, obituaries, funeral homes, which had been benchmarked against the U.S. National Death Index, demonstrating 87-92% sensitivity, 94%-99% specificity, and 96%-98% positive predictive value. Results: Of the 1,242 patients included, 969 were from HRG and 273 from NHRG, with mean age of 70.0 vs 70.8 years. For HRG and NHRG, 36.2% vs 43.6% were female, 72.0% vs 74.7% were White, 37.5% vs 39.6% were Medicare patients (due to data limitation, 18.5% and 19.8% patients had missing data for payer type, respectively), 91.6% vs 93.8% were from the community setting, 48.8% vs 53.1% were between Rai stage 0 and II, 74% vs 70.1% had ECOG ≤ 2, 47% vs 63% had deletion 13q presence, 23.5% vs 24.2% had trisomy 12 presence, respectively. Mean (Standard Deviation) time from diagnosis to 1L initiation was 35.0 (48.0) vs 64.4 (73.2) months for HRG and NHRG. Within the HRG, 32.9%, 36.7%, and 58.7% of the patients had the presence of del(17p), del(11q), and unmutated IGHV, respectively. After applying IPTW with trimming, OS hazard ratio (HR; 95% confidence interval [CI]) was 1.09 (0.79, 1.51) and median OS was not reached for either group (Figure 1). Median follow up (interquartile range [IQR]) was 32 (17, 48) months and 31 (19, 44) months, for HRG and NHRG, respectively. The HRG sensitivity analysis showed similar results to the main analysis, with OS HR (95% CI) being 1.19 (0.86, 1.64) and median OS not reached for either group. Within the Medicare subgroup, OS HR (95% CI) was 0.98 (0.63, 1.53), and median OS was not reached for either group (Figure 2). Conclusions: In this real-world study using a large community healthcare dataset, CLL/SLL patients with high-risk molecular-cytogenetic features (del[17p], or del[11q], or unmutated IGHV) treated with 1L ibrutinib had similar OS compared to patients without high-risk features. Importantly, similar findings were observed in the high-risk sensitivity analysis and the Medicare subgroup.

A qualitative exploration of forensic pathology service staff perceptions of the implementation barriers and facilitators of manual- and electronic injury mortality surveillance system methods in South Africa

BackgroundInjury mortality surveillance systems are critical to monitor changes in a population’s injury outcomes so that relevant injury prevention responses may be adopted. This is particularly the case in South Africa, where the injury burden is nearly twice the global rate. Regular evaluations of surveillance systems are pivotal to strengthening surveillance capacity, performance, and cost effectiveness. The National Injury Mortality Surveillance System (NIMSS) is an injury mortality surveillance system that is currently focused in Mpumalanga and utilises manual and electronic web-based systems for data collection. This study explored Forensic Pathology Service (FPS) staff perceptions of the implementation barriers and facilitators of manual- and electronic injury mortality surveillance system methods.MethodsA qualitative study was employed using purposive sampling. Forty-seven participants, aged 29 to 59 years comprising 31 males and 16 females were recruited across 21 FPS facilities that serve the province. The formative evaluation occurred over the November 2019 to November 2022 period. Twelve focus group discussions were thematically analysed to determine emerging themes and patterns related to the use of the system using the WHO surveillance system guidelines as a framework.ResultsThe key themes concerning the barriers and facilitators were located along WHO attributes of simplicity, acceptability, timeliness, flexibility, data quality and stability. Distinctions between the manual and e-surveillance systems were drawn upon across the attributes highlighting their experience with the system, user preference, and its contextual relevance. With Mpumalanga predominantly rural, internet connectivity was a common issue, with most participants consequently showing a preference for the manual system, even though the electronic system’s automated internal validation process was of benefit. The data quality however remained similar for both methods. With program stability and flexibility, the manual system proved more beneficial as the dataset was reported to be easily transferrable across computer devices.ConclusionObtaining FPS perceptions of their experiences with the system methodologies are pertinent for the enhancement of injury surveillance systems so to improve prospective engagements with the systems. This will facilitate timely and accurate injury mortality information which is vital to inform public policy, and injury control and prevention responses.

Association between body composition and the risk of mortality in the obese population in the United States.

Recent studies have presented the concept of the obesity paradox, suggesting that individuals with obesity have a lower risk of death than those without obesity. This paradox may arise because body mass index (BMI) alone is insufficient to understand body composition accurately. This study investigated the relationship between fat and muscle mass and the risk of mortality in individuals with overweight/obesity. We used data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2006 and 2011 to 2018, which were linked to mortality information obtained from the National Death Index. Multiple Cox regression analyses were performed to estimate mortality risk. Subgroup analysis was conducted using propensity score-matched (PSM) data for age, sex, and race/ethnicity. This study included 16,555 participants who were overweight/obese (BMI≥25 kg/m2). An increase in appendicular skeletal muscle mass index was associated with a lower mortality risk (hazard ratio [HR]: 0.856; 95% confidence interval [CI]: 0.802-0.915). This finding was consistent with the subgroup analysis of the PSM data. Contrastingly, a high fat mass index was associated with an increased risk of mortality. Sarcopenic overweight/obesity was significantly associated with high mortality compared to obesity without sarcopenia (HR: 1.612, 95%CI: 1.328-1.957). This elevated risk was significant in both age- and sex-based subgroups. This finding was consistent with the subgroup analysis using PSM data. In contrast to the obesity paradox, a simple increase in BMI does not protect against mortality. Instead, low body fat and high muscle mass reduce mortality risk.

Trend and Joinpoint Analysis of Cancer Incidence and 1-Year Mortality in North-East Spain 2005–2020

Cancer is the second leading cause of death. It is thus essential to examine cancer trends in all regions. In addition, trend data after 2019 and on cancer 1-year mortality are scarce. Our aim was to analyze incidence and 1-year mortality cancer trends in northeastern Spain during 2005–2020. We used the Osona Tumor Registry, which registers cancer incidence and mortality in Osona. The mortality information came from the Spanish Death Index. We analyzed age-standardized incidence rates and 1-year mortality by sex in the population aged &gt; 17 years during 2005–2020. Trends were examined with negative binomial and joinpoint regression. Incidence rates of colorectal, lung and bronchus, and urinary bladder cancer increased annually in females by 2.86%, 4.20%, and 4.56%, respectively. In males, the incidence of stomach and prostate cancer decreased annually by 3.66% and 2.05%, respectively. One-year mortality trends decreased annually for endometrium cancer (−9.0%) and for colorectal cancer in males (−3.1%). From 2019 to 2020, the incidence of cancer decreased, while 1-year mortality increased in both sexes. In a North-Eastern Spanish county, 1-year mortality decreased for endometrium cancer in females and for colorectal cancer in males. Our results suggest a trend of decreasing cancer incidence and increasing cancer mortality as a result of the COVID-19 pandemic.

The L-shaped association of mid-upper arm circumference with all-cause and cause-specific mortality in US adults: a population-based prospective cohort study

BackgroundThe arm circumference is a feasible and reliable indicator in evaluating the nutritional status of children. However, its application in general adults has yet to be thoroughly investigated.ObjectiveThis study aimed to evaluate the association between mid-upper arm circumferences (MUACs) and mortality in general adults.MethodsThe nationally representative cohort from the National Health and Nutrition Examination Survey (1999—2018) was analyzed with mortality information obtained through linkage to the National Death Index. The baseline MUACs were collected as exposure. Survey-weighted Cox proportional hazard regressions were performed to estimate the hazard ratios (HRs) and 95% confidential intervals (CIs) of mortality risk for individuals with different MUACs. Restricted cubic spline analyses were performed to examine the nonlinear association of MUAC with all-cause and cause-specific mortality.ResultsA total of 52,159 participants were included in this study. During a median follow-up time of 117 months, 7157 deaths were documented, with leading causes of cardiovascular disease (CVD), cancer, and respiratory disease. Individuals in the first quartile (Q1) of MUAC tended to have higher all-cause mortality risk than the rest after full adjustment. Similarly, CVD mortality risk in Q1 was higher than that in the second quartile (Q2) and the third quartile (Q3); respiratory mortality risk in Q1 was higher than in Q2. MUAC was non-linearly associated with all-cause mortality and CVD mortality. Individuals in Q1 MUAC (≤ 29.3) tended to have higher all-cause mortality risk, with HRs (95% CIs) estimated to be 0.76 (0.67–0.87) for Q2 (29.4, 32.5), 0.69 (0.59–0.81) for Q3 (32.6, 36.0), and 0.59 (0.46–0.75) for Q4 (≥ 36.1) after adjustment of demographic, lifestyle, and comorbidity covariates. Similarly, compared with Q1, HRs (95% CIs) for CVD mortality were estimated to be 0.73 (0.58–0.93) for Q2 and 0.57 (0.43–0.47) for Q3; HRs (95% CIs) for respiratory mortality was estimated to be 0.57 (95% CI, 0.37–0.87) for Q2 with other differences not significant.ConclusionThe MUAC was inversely associated with long-term mortality in general adults in the United States and may serve as a valuable measurement in adult health evaluations.

The Effects of Air Pollutants on Mortality in the Elderly at Different Ages: A Case of the Prefecture with Most Serious Aging in China

The elderly population is the main group sensitive to air pollution; however, the risks of multiple air pollutants on the elderly at different ages are not very clear. For this study, daily concentrations of five major air pollutants (PM10, NO2, SO2, CO, and O3) and daily mortality information of 173,537 people who died between 2014 to 2017 in Nantong, a prefecture with the most serious aging rate in China in 2000, 2010, and 2020, were collected; the aging people were divided into 2–6 groups according to age. A generalized additive model with a thin-plate spline function was used to study the exposure–response relationship, the excess risk, and the lag period of various pollutants on each group of the elderly, and the synergistic effect between these pollutants and temperature was demonstrated. The results revealed that, after controlling confounding factors such as temperature, humidity, and wind speed, the lag period and relative risk of most pollutants increased with age, and the adverse effect of air pollutants on the elderly lasted for 2–3 days. Among the pollutants, NO2, SO2, CO, and O3 had a longer lag period compared with PM10. Linear and non-linear exposure–response relationships were observed between the pollutants and mortality. Women were at higher risk than men for the same pollutant concentrations. Synergistic effects were observed between the five pollutants and temperature. This study could contribute to the formulation of a strategy to mitigate the effects of air pollution on the elderly at different ages and play a positive role in reducing the negative impact of air pollution on aging societies.

Abstract 16146: A Scoping Review of Adverse Outcomes Associated With Cardiac Resynchronization Therapy Device Implantation: Implications for Informed Consent

Background/Objectives: Cardiac Resynchronization Therapy (CRT) is a treatment option for many adults with heart failure with reduced ejection fraction (HFrEF). While the benefits of CRT are well-established, the downstream implications of adverse events are not well-characterized. We sought to better understand the ramifications of CRT-related adverse events on length of hospital stay (LOS) and mortality—information relevant for patients and clinicians to make informed decisions about pursuing CRT. Design: Scoping Review Methods: We conducted an initial PubMed search using terms including “Congestive Heart Failure” or “Heart Failure” and "Cardiac resynchronization" or "Cardiac re-synchronization" or "Biventricular pacing.” We reviewed resulting articles that were written in English, studied CRT devices, and outlined adverse events related to CRT device placement. We separately searched PubMed for additional articles outlining individual adverse events identified using search terms “event name,” “mortality,” and “hospital stay.” We read articles and summarized data regarding the impact of reported adverse events on hospital LOS and mortality. Results: Our search identified 18 full length articles with relevant data. The most common adverse events included device implant failure/non-response, lead dislodgment, coronary sinus dissection, and pocket hematoma. The LOS and mortality rates of each event are shown in Table 1. Of note, LOS for implantation in the ambulatory setting is up to 1 day; LOS for uncomplicated implantation during hospitalization is 4.6 days. Implantation during hospitalization with complication is mean 13.6 days. Conclusion: While absolute risks for adverse events associated with CRT implantation are low, several have important implications on hospital LOS and mortality. These findings warrant inclusion in discussion regarding the risks of CRT when clinicians and patients engage in informed decision making related to CRT.

Trends in tuberculosis incidence and mortality coefficients in Brazil, 2011-2019: analysis by inflection points.

To analyze the temporal trend of tuberculosis incidence and mortality rates in Brazil between 2011 and 2019. This was an ecological time series study of tuberculosis incidence and mortality rates in Brazil between 2011 and 2019. Data were extracted from the Notifiable Disease Information System and the Mortality Information System, and population estimates were from the Brazilian Institute of Geography and Statistics. Trends were analyzed by Joinpoint regression, which recognizes inflection points for temporal analysis. The average incidence rate of tuberculosis in Brazil in the period was 35.8 cases per 100 000 population. From 2011 to 2015, this coefficient had an annual percentage change of -1.9% (95% CI [-3.4, -0.5]) followed by an increase of 2.4% (95% CI [0.9, 3.9]) until 2019. The average mortality rate between 2011 and 2019 was 2.2 deaths per 100 000 population, with an average annual percentage change of -0.4% (95% CI [-1.0, 0.2]). Amazonas was the only state with an increase in the annual average percentage variation for the incidence rate (3.2%; 95% CI [1.3, 5.1]) and mortality rate (2.7%; 95% CI [1.0, 4.4]) over the years, while Rio de Janeiro state had an increasing inflection for incidence from 2014 to 2019 (2.4%; 95% CI [1.4, 3.5]) and annual average of decreasing percentage variation (-3.5%; 95% CI [-5.0, -1.9]). During the period analyzed, a decreasing trend in incidence was observed between 2011 and 2015, and an increasing trend for the period from 2015 to 2019. On the other hand, no change in the trend for mortality was found in Brazil.

Decreased Survival Among Patients with Indolent Systemic Mastocytosis: A Population-Level Retrospective Cohort Analysis Using Healthcare Claims Dataset

Background Systemic mastocytosis (SM) is a rare, clonal mast cell disease driven by the KIT D816Vmutation in ~95% of cases and can be subdivided into two predominant subtypes - advanced SM (AdvSM) and indolent SM (ISM). AdvSM comprises ~15% of all patients and is characterized by mast cell proliferation and infiltration causing subsequent dysfunction of various organ systems, leading to reduced overall survival. Indolent systemic mastocytosis (ISM) comprises the bulk of the remaining ~85% of patients and is characterized by a less severe clinical course that is nevertheless associated with a significant symptom burden that may worsen over time, poor quality of life, and the potential for life-threatening anaphylaxis. Recent epidemiologic data indicate ISM is a heterogenous disease. A meaningful subset of patients with disease risk factors demonstrates high symptom burden, which may be associated with higher rates of disease progression and increased risk of death (Sperr, et al. Lancet Hematol. 2019). Building upon this work, we conducted an analysis to evaluate overall survival (OS) in ISM patients. Methods Using a nationally representative health claims dataset provided by Komodo Health covering 230 million US patients (2015 to 2022), we identified 8,332 patients with ISM using a claims-based algorithm. This algorithm leverages combinations of ICD-10 dx codes for SM and organ dysfunction, procedure codes (bone marrow biopsy), and use of SM-directed therapies (Mukherjee et al ASH 2022). Patients were included if full medical and pharmacy claim information was available for &amp;gt;12 consecutive months post-diagnosis, and median follow-up was 4.0 years. ISM was inferred as a dx if only the broad systemic mastocytosis ICD-10 code was used (D47.02) and there was no preceding evidence of AdvSM or an associated hematologic neoplasm. Disease progression to AdvSM was inferred if there was subsequent evidence of mast cell leukemia, aggressive SM, or an associated hematologic neoplasm OS was then calculated, anchored to the first observed ICD-10 dx code for SM. Mortality information was available within the claims dataset and was additionally inferred if a patient did not generate any medical or pharmacy claims for 12 or more consecutive months. Three, independent non-SM control cohorts (N=2000 each) were established for comparison, based on a stratified sampling strategy matched by gender, age, Charlson Comorbidity Index, payer status, and race/ethnicity of the ISM population. Multiple cohorts were plotted to illustrate consistency in survival across independently-sampled control cohorts. As positive control, we compared OS with a cohort of patients with ASM, a disease cohort with known increased mortality. Results We observed a statistically significant difference in OS among patients with ISM versus the matched non-SM control cohorts ( p&amp;lt;0.0001, with a log-rank hazard ratio of 1.64; Figure 1A). Excess mortality was noted among ISM patients with or without evidence of disease progression ( p&amp;lt;0.0001, with a hazard ratio of 1.44) compared to matched non-SM cohorts ( Figure 1B). As expected, OS was worst in patients with AdvSM ( p&amp;lt;0.0001, with a hazard ratio of 6.64). The ISM cohort presented to the emergency room (ER) 0.70 times per year, compared to 0.31 times per year for the combined non-ISM control cohorts, based on the sum of ER visits observed across the cumulative cohort observation period. Patients with ISM who died during the study interval had the highest frequency of ER visits, at a rate of 1.09 visits per year. Conclusions This is the first and the largest population-level analysis of OS in the ISM population in the US. Results demonstrate a modest but statistically significant decrease in survival among these patients even early in their disease course (first 4 years). This increase in mortality was observed even among patients with no evidence of progression to advanced SM and was additionally associated with &amp;gt;2x higher rates of ER visits over the observation period. These results suggest that acute, severe symptoms of SM may contribute to the excess mortality seen among patients with ISM and warrant focused research to identify specific patient characteristics or disease features in ISM that confer higher risk of mortality.

Exploring factors and trends in place of death by cancer: A population-based study in Brazil.

237 Background: Place of death serves as an indicator of the quality of end-of-life care. This study seeks to elucidate the place of deaths by cancer in Brazil, also identifying factors contributing to regional disparities in end-of-life settings. Methods: Using data obtained from the National Mortality Information System, this study extracted sociodemographic characteristics and the location of cancer deaths in Brazil from 2012 to 2021. The place of death was classified into hospital death, home death, and other settings (not shown). Results: A total of 2.165.643 deaths by cancer were included. Almost half of the cases were from Southeast (47.4%), while 22.0% were from Northeast, 19.0% from South and the minority from Central-west (6.5%) and North (5.0%) regions; remarkably, 73.3% of deaths occurred out of capitals. A downward trend was observed from 2012 to 2021 with a Relative Percent Difference (RPD) of -4,0. The frequency of deaths occurring at home in the Northeast region (26.6%) was found to be higher than the reference region, the Southeast (10.6%), RPD -22.2. Furthermore, Indigenous individuals showed a higher frequency of death at home (25.4%) compared to White ethnicity (14.2%), RPD -18.4. A clear inverse relation between in-hospital deaths and aging can be noted, as more at-home deaths are observed in the elderly (17.8%) compared to the young group (4.1%). Conclusions: Most cancer deaths in Brazil occur in hospitals. Death at home is related to pronounced regional differences, being higher in the North and Northeast, and may be related to advanced age, race and educational level.[Table: see text]

Mortality from neglected tropical ciseases in Brazil in the 21st Century: Analysis of spatial and temporal trends and associated factorsMortalidad por enfermedades tropicales desatendidas en Brasil en el siglo XXI: análisis de tendencias espaciales y temporales y factores asociados

To analyze the spatial-temporal distribution and factors associated with mortality from neglected tropical diseases (NTDs) in Brazil from 2000 to 2019. We performed an ecological study to analyze NTD-related deaths recorded in the Ministry of Health Mortality Information System (SIM). For the temporal analysis, the joinpoint method was used. Spatial dependence was analyzed using global Moran and local Getis-Ord Gi* indices. Four non-spatial and spatial regression models were used to identify factors associated with mortality. The mean mortality rate from NTDs in Brazil during the study period was 3.32 deaths per 100 000 inhabitants, with the highest rate (8.68 deaths per 100 000 inhabitants) recorded in the Midwest. The most prevalent causes of death were Chagas disease (n = 94 781; 74.9%) and schistosomiasis (n = 10 271; 8.1%). There was a 1.24% reduction (95%CI = -1.6; -0.9; P < 0.001) in NTD-related mortality in Brazil per year. A high/high spatial distribution pattern and hotspots were observed in municipalities in the states of Goiás, Minas Gerais, Bahia, Tocantins, and Piauí. The indicators "population in households with density > 2 people per bedroom" (β = -0.07; P = 0.00) and "municipal human development index" (β = -3.36; P = 0.08) were negatively associated with the outcome, while the "index of social vulnerability" (β = 2.74; P = 0.05) was positively associated with the outcome. Lower human development and higher social vulnerability are associated with higher mortality from NTDs, which should guide NTD prevention and control efforts.

Mortalidade infantil por causas evitáveis

Infant mortality refers to deaths of children under one year of age, subdivided into neonatal mortality (early and late neonatal) and post-neonatal mortality, being considered an indicator for assessing the population's health situation. The study aimed at describing the infant mortality rates due to preventable causes, in children under one year of age and in the state of Alagoas, during 2017. A descriptive and cross-sectional ecological study was carried out, with a quantitative approach on mortality rates in the age group of children under one year old, based on secondary data available in the Mortality Information System, by the Informatics Department of the Unified Health System (Departamento de Informática do Sistema Único de Saúde, [DATASUS]). This study was carried out from November to December 2019. During this period, in the state of Alagoas, 793 deaths due to preventable causes among children under five years of age were recorded in the Informatics Department of the Unified Health System. 83.98% (n=666) of these deaths corresponded to children under one year of age, with death cases in the early neonatal period being the most prevalent, followed by deaths in the post-neonatal and late neonatal periods. Among the cities in Alagoas, Maceió ranks first and Arapiraca is in second place in relation to the infant mortality rate.